Texas Department of Insurance Working for You

who governs insurance companies

(August 2015)

The Texas Department of Insurance protects insurance consumers by

  • regulating the industry fairly and diligently
  • promoting a stable and competitive market
  • providing information that makes a difference.

This publication tells you about our services and has a list of helpful telephone numbers. For additional information or answers to general insurance questions, call our toll-free Consumer Help Line at 1-800-252-3439 or visit our website at www.tdi.texas.gov .

Regulating the Insurance Industry

Licensing

Texas law requires most insurance companies and insurance-related businesses to be licensed before selling their products or services. TDI licenses:

  • insurance companies and agents
  • third-party administrators
  • health maintenance organizations (HMOs)
  • premium finance companies
  • continuing care retirement communities
  • insurance adjusters
  • public insurance adjusters.

Compliance and Enforcement

TDI also issues rules and regulations for the state's insurance industry, enforces Texas insurance laws, investigates misconduct, and takes enforcement action against companies and agents.

TDI may fine or penalize agents and companies that delay claims payments, misrepresent policies, violate statutory rate standards and rating requirements, or use unfair and unlawful practices.

Financial Regulation

To ensure that insurance companies have money to pay claims and expenses, TDI looks at companies' financial conditions and enforces rules to make sure they stay solvent.

TDI also publishes company profiles that show a company's complaint record and other useful information, including the company's history and any enforcement actions TDI has taken against the company. For a company profile, call our Consumer Help Line or use the Company Lookup feature on our website.

Insurance Fraud

TDI investigates insurance fraud and helps prosecute offenders. The most common types of fraud are selling insurance without a license, over-billing insurance companies, padding claims, or filing claims for losses that didn't happen.

TDI refers civil cases to the Texas Attorney General's Office and reports criminal cases to local district attorneys and United States attorneys. To report suspected insurance fraud, call the Consumer Help Line.

Advertising

TDI looks at insurance advertising and marketing materials to make sure they comply with laws and rules, to detect possible fraud, and to guard against misrepresentation. TDI can penalize insurance companies and agents who use unfair trade practices or deceptive advertising by giving warnings, fines, license revocations, and other penalties. In some cases, TDI may require companies to refund premiums to consumers.

Technical Analysis

TDI collects and analyzes data,

reviews the rates companies file with TDI, and provides information to help policymakers and consumers. The section also helps the agency detect problem insurance companies.

Division of Workers' Compensation (DWC)

TDI regulates the state's system to pay medical and income benefits to workers who are injured at work or who have work-related illnesses. The division

  • licenses workers' compensation insurance companies and networks
  • approves companies that want to self-insure
  • enforces workers' compensation laws and rules
  • promotes worker health and safety
  • provides access to medical care for injured workers
  • administers a dispute resolution system for disputes involving workers' compensation benefits
  • provides services to facilitate an injured worker's return to work.

Helping Consumers

Consumer Help Line

TDI's toll-free Consumer Help Line assists callers with insurance questions and concerns. The help line is available Monday through Friday from 8 a.m. to 5 p.m. Central time.

Complaint Assistance

TDI helps consumers recover millions of dollars in refunds and additional claim payments each year. If you have a complaint against an insurance company or agent, first notify your company. If you still aren't satisfied, you may formally complain to TDI. You may submit a written complaint in the following ways:

Consumer Protection (111-1A)

P.O. Box 149091

Austin, TX 78714-9091

Workers' Compensation Medical & Income Benefit Dispute Resolution

DWC resolves disputes about medical and income benefits paid to workers who suffer work-related injuries or illnesses. If you have a dispute involving workers' compensation benefits, call Customer Assistance  at 1-800-252-7031.

Public Education and Publications

TDI gives presentations on insurance and trains volunteers to help older Texans with insurance concerns. We produce free publications and rate guides to help you better understand insurance and to help you shop for the insurance you need. Visit our website to view our publications online or call our Consumer Help Line to have publications mailed to you.

Disaster Response

TDI sends disaster response teams to affected areas after disasters. These teams provide information about insurance, help people file claims, and help with consumer complaints.

State Fire Marshal's Office

  • conducts arson investigations
  • conducts fire safety inspections
  • collects data from fire departments and publishes a summary useful for development of laws, standards, and prevention programs
  • enforces fire extinguisher, sprinkler, and alarm laws
  • licenses and regulates fireworks
  • educates children and consumers on fire prevention and safety.

Source: www.tdi.texas.gov

Category: Insurance

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